calcification

[JRSK]

I am 39 yrs ago and 15 months ago I went in for my baseline mammogram.  The end result was 2 stereotactic biopsies (one in each breast).  I just went back for another mammo and more clusters of micro calcification's were found again in the Right breast.  I don't think I can go through this biopsy again.  I am scheduled for Monday the 25th.  I can not take the pain during or after and the months of extreme tenderness.  I currently can't sleep or eat due to anxiety of knowing what I am about to go through again...Is it necessary to do this again since the first two were nothing?  Will these calcification's continue to develop?  Am I at a higher risk for B/C (DCIS) because calcification's keep develpoing?  What other options do I have to avoid this horrible/painful procedure?

I am so scared I will spend a month every year going through this process...anxiety, horrible pain, lack of sleep...What should I do to end this madness every year??  Please tell me I have options!

[JRSK]

I am very glad your result came back Neg!!  I am not sure why mine are/went the way they did in the past but they were really bad.  I had a friend go with me in the past and they let her in the room to comfort me and when telling her I had to do it again for the third time.. her reaction was the same as mine!! No Way< I will take this info with me a talk to the Dr. regarding what is being used.  In the meantime.. Monday is still a long way away.  I do worry about the amounts and the effects from the radiation used during the procedures.  The first time I was not concerned, the second time I raised an eybrow and now on the third I am starting to question..  Unfortunately, questioning does NO good.  I just get told it's fine!!  Well, if its so fine.. Stay in here with me!!  Ha Ha

[prbhurst]

I hear you!  And, you make very good points.  

I believe it comes down to each individual woman, their own situation, their own thoughts, feelings, tolerance and trust.  

Unfortunately, we are limited and hindered in making choices by all that you state above.  I sometimes think mainstream medicine is "flying blind" so to speak, and is limited because there is much they still don't know.  Throw in corporate insurance, and you have even more issues.

Ultimately, we have to be aggressive in our own care, and be as knowledgeable as possible.  

I understand you're frustration and anger with the situation, and certainly the need to vent.  I wish there were a simpler way to know the right decision, but there isn't.

My best to you...

[JRSK]

OK,  First of all Thank You for all your feedback and input...
I have:
   Mammographically complicated Breasts.
   To Many Fiberous Cysts to Count in both breasts
   Very Dense Tissue
   Conitnued Micro-Calcification Development
   Family History....

All of the above to live with and NO Solution???
Options...
   MRI"S and deal with MORE False Alarms, increased anxiety/fear and more biopsies.
   Continue on an annual basis with the multiple mammo's and magnifications followed
       up with the stereatactic biopsies (which, I beleive are harmful when do too often)
   And fall through the cracks of Corp. (Ins.) America who essentially makes the            
       decision because of the "boob box" the ACS has drawn.

U/S and Thermography technology are not quite there yet as far as accuracy because they both produce TOO many False alarms but so do the MRI"S and Mammo's in  women  with my breaast type..

The development of the saliva test wont be readily available for several years and then there is the unknown accuracy of that to be determined for several years after it is readily available (just like all the other tests).

SO...basically in a nut shell, I get to sit here and just continue with this lack of quality of life a month every year, anxiety, fear, stress, painful procedures.  I get to live this way until someday in the future (2 yrs?, 5 yrs.?, 20yrs.?) I get the diagnosis of CANCER!!!  From what I am hearing... There are MANY of us women out there walking in my shoes everyday...  I know I am ranting but what is the point of "breast Cancer Awareness" when it feels like all it does is make you aware of the fact that you will probably get cancer but there is nothing you can do.  Just sit and take it!!!  Continue to go through all these scares, Painful procedures and wonder every day of your life if this time it will be IT!!

I would rather just have them removed, reconstruct the size I have (small, size A and I like them that way) and get on with my life.  If there is no way to deal with these Kind of breasts just take them away for ever.   Some may be mad at this statement, Some may agree, Some may call it radiacal, and  thats OK..  I call it logical, in the abscence of a solution; just get rid of the problem....

How Do others with this breast type feel and do they get though the anxiety, stress and fear???

[prbhurst]

I thought I would comment on my own stereotactic biop last Tuesday.  I was fortunate to get results the next day...benign.

My biop was not as pain-free as I would have thought.  I asked for local, but wonder if I got enough.  I recall hearing the doc and nurses commenting on whether the dial (or something) was working, though their comments made it sound like they'd finally figured it out.  I did feel pain, or maybe it was pressure, but the bottom line is I felt something.  I endured it, as I just wanted it done.

The week since has been mostly pain free, though my breast has been a little sore, but nothing major.  I bruised about 4 days after, and today (1 week post) the bruise is gone.

The comment about epinephrine possibly be absorbed is interesting.  That could very well be the cause of some of your symptoms.

I too wonder if more microcalc's will show up in the future, as I don't want to go through it again.  But, I know that possibility it there.  

My best to you, and good luck.

[Computer_Voice]

I hear you.  The problem you describe is one faced by many women.  Some women even have the extra burden of having complicated breasts (from a medical imaging standpoint) and a very strong family history or other set of risk factors that even ups the anxiety another notch.  Unfortunately, there doesn't exist a good solution to the problem.  

One approach would be to be screened annually with breast MRI in addition to mammography.  The first MRI you had though, would likely show one or more false alarms because of your unique anatomy and physiology which would exacerbate the situation at first, but once you had a good MRI baseline established, the test would become more accurate because the interpreter would only be looking for significant changes from the years prior and would be comfortable dismissing otherwise concerning findings which otherwise have remain unchanged and are therefore not cancer.  This still won't completely eliminate the problem because the rule is that suspicious calcifications on a mammogram are thought to warrant biopsy even when the MRI is normal.  It would, however, give you and your doctor extra confidence to increase the threshold for biopsy.

The one hitch to this whole plan is that insurance companies are currently only paying for annual screening breast MRIs (very expensive) when patient's meet a certain criteria of risk factors as outlined by the American Cancer Society (ACS).  Even though we know mammographically dense breasts increases the risk of developing breast cancer, and we know that MRI is very effective for screening mammographically dense breasts--in conjunction with annual screening mammography, for some reason it was not a factor which is included in the current ACS recommendations, and insurance companies are quick to remind you of this.  The decision may in part be political/financial because the system might have a hard time accommodating the sheer numbers of women with dense breasts.  

Studies on screening ultrasound are looking promising, but it's not there yet for a number of good reasons.  The one that should make you most wary is that screening ultrasound as it is currently practiced significantly increases the number of unnecessary biopsies performed.  There is hope for the future with screening ultrasound however, but not in 2008.

Thermography is firmly in the realm of snake oil at the present time, but that may also change in the future.  Just because it doesn't compress the breast (pain) and doesn't use radiation like a mammogram doesn't make it harmless, either.  The harm is that it will much too often give false reassurance that nothing is wrong, when in fact cancer may be brewing, and that it too often gives false alarms that result in lots of unnecessary workups, biopsies and anxiety.

Believe it or not, there's work being done on developing a chemical test from saliva to check for breast cancer metabolites which has a lot of potential to separate women who need further imaging workup from those who don't.  It's currently not ready for prime time, but hopefully will be at some point not too far into the future.

[JRSK]

Think charlatan?? What does that mean?
So If I am mammographically complicated, very dense breasts with many many cysts;  what do I do?  I can't continue with all these painful biopsies, annual anxiety for a month and living with the feelings I have about my breasts...  It's not quality of life!!

[Computer_Voice]

It sounds like you probably absorbed some the epinephrine usually mixed in the local anesthetic which would cause the symptoms you described.  Ask them next time to use only lidocaine without the epinephrine.  Thermography is again being studied, but currently is not useful.  I certainly wouldn't trust anyone offering thermography except in a research setting.  One of the (many) big problems with thermography is that it creates problems that it cannot solve.  In other words, when a scan is positive you then have to go for a lot of additional mammograms and ultrasounds to try to find what lit up on the thermogram, and usually it will turn out to be a false alarm--exactly what you are trying to avoid.  Possibly in a few years thermography will have a role in screening depending on how the current research pans out, but not at this time.  Think charlatan.

[JRSK]

I know that this biopsy should be "minimal pain" "non-invasive" but it's not>> I have had two so far and they were both horrible... Throwing up from the pain, excessive bleeding that caused me to pass out, inablility to breathe well after the procedure due to the pain,  heart just racing and pounding really bad.  I was very scared after the procedures.  I can't understand why anyone would call this "not that bad".  Not the mention the bruising and it took 8 months before my kids could hug me tight with out pain... And it was done at a Breast Center...

I will find out the Birads number tomorrow and go from there.  I do have mammographically complicated and dense breasts so I guess that's just fun for me..
What about Thermography??

[Computer_Voice]

Oddly enough, a benign biopsy actually does place one at a slightly higher risk of developing breast cancer in the future, although it's purely a statistical thing and has nothing to do with the effects of the biopsy itself and should NOT be interpreted that a benign biopsy 'causes' increased risk in an individual.  It's just that when you study 1000 women who have had benign biopsies at some point in their lives, they will have as a group a slightly higher incidence of breast cancer, but not at the site of the prior benign biopsy.  The relationship is probably that women who have had benign biopsies usually have somewhat more complicated breast tissue that makes the mammogram more difficult to interpret, and there is some evidence of a higher incidence of breast cancer in mammographically complicated breasts, just as there is in mammographically dense breasts.  But that's too much information, and the increased risk is negligible and not one you should concern yourself at all with.

The better and equally true answer is that having benign calcifications does not place you at a higher risk of developing breast cancer.  Calcifications result either from benign or malignant causes and there is no crossover.  I would suggest getting a second opinion on the mammographic interpretation, preferably from a specialty breast center or university teaching hospital.  The threshold for recommending biopsy of many general radiologists in the community tends to be fairly low, while specialists who do nothing but read mammograms day in and day out are often more comfortable calling calcifications benign based soley on their mammographic appearance unless they appear truly suspicious.

If needed, I would also have the biopsy at a university or breast center, because there really shouldn't be any/much pain associated with the procedure when done by someone with a lot of experience--although soreness afterwards can be significant.  

Find out how suspicious the cluster of calcifications you are scheduled to have biopsied on the 25th.  If they are a small group that is only minimally suspicious --Birads 4A-- then you may want to postpone the procedure while you get a second opinion.  If the radiologist has classified them as more suspicious --Birads 4C or 5-- then I would bite the bullet and have them biopsied without the second opinion which would probably just echo the first opinion and add delay without benefit.  

[Computer_Voice]

Oddly enough, a benign biopsy actually does place one at a slightly higher risk of developing breast cancer in the future, although it's purely a statistical thing and has nothing to do with the effects of the biopsy itself and should NOT be interpreted that a benign biopsy 'causes' increased risk in an individual.  It's just that when you study 1000 women who have had benign biopsies at some point in their lives, they will have as a group a slightly higher incidence of breast cancer, but not at the site of the prior benign biopsy.  The relationship is probably that women who have had benign biopsies usually have somewhat more complicated breast tissue that makes the mammogram more difficult to interpret, and there is some evidence of a higher incidence of breast cancer in mammographically complicated breasts, just as there is in mammographically dense breasts.  But that's too much information, and the increased risk is negligible and not one you should concern yourself at all with.

The better and equally true answer is that having benign calcifications does not place you at a higher risk of developing breast cancer.  Calcifications result either from benign or malignant causes and there is no crossover.  I would suggest getting a second opinion on the mammographic interpretation, preferably from a specialty breast center or university teaching hospital.  The threshold for recommending biopsy of many general radiologists in the community tends to be fairly low, while specialists who do nothing but read mammograms day in and day out are often more comfortable calling calcifications benign based soley on their mammographic appearance unless they appear truly suspicious.

If needed, I would also have the biopsy at a university or breast center, because there really shouldn't be any/much pain associated with the procedure when done by someone with a lot of experience--although soreness afterwards can be significant.  

Find out how suspicious the cluster of calcifications you are scheduled to have biopsied on the 25th.  If they are a small group that is only minimally suspicious --Birads 4A-- then you may want to postpone the procedure while you get a second opinion.  If the radiologist has classified them as more suspicious --Birads 4C or 5-- then I would bite the bullet and have them biopsied without the second opinion which would probably just echo the first opinion and add delay without benefit.  

[japdip]

The biopsies you mention really shouldn't be all that painful. Have you discussed this with the Radiologist or whomever is doing your procedures? If not, you should.The pain and post biopsy sensitivity you describe aren't the norm and you should expect a better experience. I woudn't advise you to ignore the recommndations as suspicious areas should always be investigated.